Report indicates e-cigarettes may have benefits for individuals but an overall negative impact on society

January 30, 2018|7:17 p.m.| Marcus Plescia, MD, MPH

On Jan. 23, the National Academy of Sciences, Engineering, and Medicine released a report that has important implications for public health practice. The report is the first to systematically address a number of important scientific and health questions that have emerged as use of electronic cigarettes has become widespread. The report provides a number of important findings:

(1) There is evidence that e-cigarette vapor contains less toxins than combustible cigarette smoke.

Many of the toxic and carcinogenic products in cigarette smoke are a result of the combustion process. E-cigarettes, which do not burn tobacco, seem to be less harmful than combustible tobacco products. However, the report notes that the long-term implications of e-cigarette use on individuals’ morbidity and mortality are not yet clear.

Use of e-cigarettes by current adult smokers can help some individuals reduce consumption of combustible cigarettes and ultimately quit smoking. At this time, there is limited evidence to suggest that e-cigarettes are effective smoking cessation aids for the population as a whole.

(2) There is evidence that e-cigarettes are a gateway to more harmful health behaviors, particularly for youth and young adults.

The use of e-cigarettes results in nicotine addiction.

Youth who regularly use e-cigarettes are more likely to begin using combustible tobacco products, and are likely to use those products at a greater frequency and intensity.

(3) There is evidence that secondhand e-cigarette emissions contain chemicals but at a lower rate than secondhand cigarette smoke. The report does not draw conclusions about the potential health effects of secondary exposure.

Indoor e-cigarette use does increase airborne concentrations of nicotine and other particulate matter within the indoor environment and may do the same for indoor surfaces. However, concentrations are lower than that of secondhand cigarette smoke.

The liquid emission of e-cigarette vapor is highly dependent on the characteristics of the e-liquid, the electronic vaporizing device, and how the user operates the device.

Implications for States

The report suggests that e-cigarette usage may have health benefits for individual smokers, insofar as they are a viable harm reduction strategy if users reduce consumption of combustible tobacco products. While FDA-approved nicotine replacement therapies (NRT) are regulated, safe, and effective cessation aids, the report suggests that there is limited evidence that e-cigarettes may have similar benefits. To improve the population’s health, states should continue to increase the availability of FDA-approved NRT products for smokers interested in quitting, promote free NRT through state quitlines, and offer comprehensive cessation coverage through Medicaid programs.

The report also indicates that increased e-cigarette use will have a negative impact on population health. It is widely known that most smokers begin smoking before the age of 18. Use of e-cigarette products has rapidly increased among youth in recent years, with e-cigarettes offering a gateway to combustible tobacco products. While e-cigarette use may benefit individual adult smokers by helping those who currently smoke reduce consumption of combustible tobacco products, they could ultimately undermine progress in reducing youth initiation. Historically, public health interventions to keep youth from starting to smoke have had a greater impact on population health than interventions to help smokers quit.

Aggressive efforts are necessary to reduce the allure and availability of e-cigarettes among youth. Policies that restrict access to all tobacco products, including e-cigarettes, as well as evidence-based practices that reduce use of tobacco products among youth should be widely implemented while also pursuing other comprehensive tobacco control strategies such as clean indoor air policies.

Marcus Plescia is chief medical officer of ASTHO. For the past fifteen years, Plescia has served in public health leadership roles at the state, local, and federal levels, including director of chronic disease for the North Carolina Division of Public Heath, director of national cancer control programs at CDC, and county public health director in Charlotte, NC.